Kaarid 250

Description

Kaarid 250 Tablet is prescribed to treat a wide range of bacterial infections. These include:

• Respiratory tract infections: Such as pharyngitis, tonsillitis, acute maxillary sinusitis, acute bacterial exacerbation of chronic bronchitis, and pneumonia (including community-acquired pneumonia and legionellosis).
• Skin and soft tissue infections.
• Leprosy.
• Peptic ulcer disease: Particularly when caused by Helicobacter pylori. It’s typically used as part of a multi-drug regimen to eradicate the bacteria.
• Lyme disease.
• Acne.

How Do You Take It?

The exact dosage and duration of treatment will be determined by your doctor based on the specific infection and your individual needs. Always follow your doctor’s instructions precisely.

Adult Dosing (Oral)

• Acute Exacerbation of Chronic Bronchitis: 250-500 mg by mouth every 12 hours for 7-14 days. An extended-release (XL) form may be 1000 mg once daily for 7 days.
• Mycobacterial Infection (Prophylaxis and Treatment): 500 mg by mouth every 12 hours for 7-14 days. This is typically used in combination with other anti-mycobacterial drugs like rifampin and ethambutol.
• Peptic Ulcer Disease: 500 mg by mouth every 8-12 hours for 10-14 days. It is administered as part of a 2- or 3-drug combination regimen, which may include bismuth subsalicylate, amoxicillin, an H2 receptor antagonist, or a proton pump inhibitor.
• Pharyngitis, Tonsillitis: 250 mg by mouth every 12 hours for 10 days.
• Community-Acquired Pneumonia, Skin/Skin Structure Infection: 250 mg by mouth every 12 hours for 7-14 days. Extended-release may be 1000 mg once daily for 7 days.
• Endocarditis Prophylaxis: 500 mg by mouth 30-60 minutes before a surgical procedure.

Adult Dosing (Intravenous)

• Respiratory tract infections; Skin and soft tissue infections; Susceptible infections: 500 mg twice a day for 2-5 days. It should be infused over 60 minutes using a 0.2% solution. Oral therapy should be initiated as soon as possible.

Adult Dosing (Topical)

• Apply a thin layer to the affected area once daily.

Child Dosing (Oral)

• 15 mg/kg per day, with a maximum of 1 gram per day, given every 12 hours.

Renal Impairment

• If your creatinine clearance (CrCl) is less than 30 ml/min, your dosage may need to be halved, or the dosing interval doubled.

Administration

• Standard release tablets and oral suspension: Can be taken with or without food.
• Extended-release (XL) and modified-release (MR) tablets: Should be taken with food. Swallow these tablets whole; do not chew or crush them.

Important Considerations

Contraindications (When NOT to take it)

• If you have a known hypersensitivity to clarithromycin or other macrolide antibiotics.
• If you are currently receiving medications such as terfenadine, astemizole, pimozide, cisapride, or ergot derivatives (e.g., ergotamine or dihydroergotamine), as concurrent use can lead to serious and potentially fatal interactions.
• During pregnancy.
• If you have a history of acute porphyria.

Precautions

• Use with caution if you have kidney or liver impairment. Dosage adjustments may be necessary.
• Be aware of the potential for macrolide cross-resistance.
• Lactation: Clarithromycin is excreted into breast milk. Use with caution, and consult your doctor.
• Children: Use with caution as directed by a physician.

Drug Interactions

Clarithromycin is known to interact with many other medications, potentially altering their effects or increasing the risk of side effects. Some significant interactions include:

• Reduced efficacy of clarithromycin: With strong CYP3A inducers (e.g., phenytoin, carbamazepine, efavirenz, rifampicin).
• Increased plasma levels and/or toxicity of other drugs:
  • Antiarrhythmics: Quinidine, disopyramide (risk of Torsades de pointes).
  • Phosphodiesterase inhibitors: Sildenafil, tadalafil, vardenafil (increased exposure).
  • Cardiac glycosides: Digoxin (increased risk of toxicity).
  • Antivirals: Ritonavir (inhibition of metabolism), atazanavir, itraconazole, saquinavir (bi-directional interactions).
  • Calcium channel blockers: Verapamil (risk of hypotension, bradyarrhythmias, lactic acidosis).
  • HMG-CoA reductase inhibitors (Statins): Increased risk of myopathy, including rhabdomyolysis.
  • Oral hypoglycemic drugs (e.g., pioglitazone) and insulin: Increased risk of hypoglycemia.
  • Oral anticoagulants (e.g., warfarin): Increased risk of serious hemorrhage and elevated INR/prothrombin time.
  • Aminoglycosides: Increased ototoxicity.
  • Triazolobenzodiazepines: (e.g., midazolam) Increased and prolonged sedation.
• Potentially Fatal Interactions:
  • Concurrent use with ergot alkaloids (e.g., ergotamine or dihydroergotamine): This is associated with acute ergot toxicity, characterized by vasospasm and ischemia of the extremities.
  • Concomitant use with astemizole, cisapride, pimozide, and terfenadine: This may result in QT prolongation or ventricular cardiac arrhythmia.

Adverse Effects (Side Effects)

Common side effects of Clarithromycin typically affect the gastrointestinal system:

• >10%: General gastrointestinal effects (13%).
• 1-10%: Abnormal taste (adults, 3-7%), diarrhea (3-6%), nausea (adults, 3-6%), vomiting (adults, 1%; children, 6%), elevated blood urea nitrogen (BUN; 4%), abdominal pain (adults, 2%; children, 3%), rash (children, 3%), dyspepsia (2%), heartburn (adults, 2%), headache (2%), elevated prothrombin time (PT; 1%).

Less common (less than 1%) but more serious side effects can include:

• Anaphylaxis, anorexia, anxiety, Clostridium difficile colitis, dizziness, dyspnea, elevated liver function tests, glossitis, hallucinations, hepatic dysfunction, hepatitis, hypoglycemia, increased alkaline phosphatase, increased aspartate aminotransferase, increased bilirubin, increased serum creatinine, jaundice, leukopenia, manic behavior, neuromuscular blockade, neutropenia, pancreatitis, psychosis, QT prolongation, seizures, Stevens-Johnson syndrome, thrombocytopenia.
• Topical application: May cause dryness, irritation, itching, peeling, redness, or swelling of the skin.
• Potentially Fatal: Pseudomembranous colitis, anaphylaxis, Stevens-Johnson syndrome.

How Does it Work?

Clarithromycin is a macrolide antibiotic. It exerts its antibacterial action by inhibiting bacterial protein synthesis. It achieves this by binding specifically to the 50S ribosomal subunit of susceptible organisms. This binding disrupts the bacteria’s ability to produce essential proteins, thereby stopping their growth and multiplication. It is active against various susceptible bacteria, including certain streptococci, staphylococci, B. catarrhalis, L. spp, C. trachomatis, and U. urealyticum.